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The Essentials of Negative Pressure Wound Therapy (NPWT): Part 2

Apr 22 2016
by Lisa Bonsall, MSN, RN, CRNP

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I have learned quite a bit on my journey to gaining a better understanding of Negative Pressure Wound Therapy (NPWT). In Part 1 of this series, I provided an overview of NPWT, including what it is, how it works and the risks and benefits. In Part 2 of the series I will review the practical application of NPWT including prescribing orders, procedural steps, general patient care, and tips to troubleshoot the device. Let’s jump in!

What are the steps in applying NPWT? Each device has a specific design and manufacturer’s instructions for use that should be reviewed. The following procedural steps provide a general guide.

Pre-medicate the patient for pain as needed and as prescribed.

Prepare the wound by:

removing the prior dressing very carefully to avoid tissue damage and bleeding

debriding the wound, performed by a qualified practitioner

cleansing the wound as needed/prescribed

assessing wound size and depth

Cut foam dressing to size and place into the wound. Document the number of foam pieces used; foam acts as a filter to catch blood clots and large tissue particles that might clog the vacuum system.

Trim clear occlusive dressing to size, peel back one side of Layer 1 and place adhesive side down over wound. (see photo 1)

Remove the remaining side of Layer 1 ensuring it creates a tight seal.

Cut a hole into the clear dressing about the size of a quarter (2.5 cm). (see photo 2)

Remove Layer 1 from adhesive pad connected to the pump tubing.

Place pad and tubing directly over hole affixing it to the clear dressing. (see photo 3)

Remove Layer 2 from the adhesive pad.

Connect pad tubing to canister tubing and be sure the clamps are open.

Turn on power to the vacuum device, set the prescribed pressure settings, and confirm that the dressing and foam shrink down. (see photo 4)

Wound Care Tips:

Use protective barriers, such as non-adherent or petroleum gauze, to protect sutured blood vessels or organs near areas being treated with NPWT. 2

Count and document all pieces of foam or gauze on the outer dressing and in the medical record, to help prevent retention of materials in the wound; 2 when possible, only use one piece of foam dressing.

With a heavy colonized or infected wound, consider changing the dressing every 12 to 24 hours as directed by the prescribing clinician.2

Confirm that the unit is on and set to the appropriate negative pressure, that the foam is collapsed and the NPWT device is maintaining the prescribed therapy and pressure. 2

Be sure the negative pressure seal has not been broken and leaks are minimal.4

Ensure there are no kinks in the tubing and that all clamps are open.4

Address and resolve alarm issues; reasons for the unit to alarm include: canister is full, there is a leak in the system, battery is low/dead, therapy is not activated.

Do not leave the device off for more than two hours; while device is off, apply a moist dressing 2 and notify the prescribing clinician immediately.

Avoid getting the electrical device wet; educate the patient to disconnect the unit from the tubing and clamp the tubing before bathing.

Check the drainage chamber to make sure it is filling correctly and does not need changing.4

While I am not an expert in the field of wound care, I am now more confident and better prepared to manage patients receiving Negative Pressure Wound Therapy. I would love to hear your experiences. Let me know if you have any tips or other suggestions that can help nurses and patients safely operate and maintain these devices.

I worked for a negative pressure company for 12 years and I would strongly recommend changing the dressing, especially if black foam is being used, no longer than every 3 days. If you have a healthy patient with adequate nutrition the granulation tissue will grow quickly and move into the foam. Allowing this to happen for more than 48 hours can result in difficulty removing the foam and cause unnecessary pain to the patient. If a wide mesh barrier dressing is used, that can prevent adherence. Vaseline gauze should not be placed in the wound bed, unless over exposed bone or vessels, because it will obstruct the flow of negative pressure.